Models Of Disease In Nursing Education What are Patient Lay Models of Disease in Nursing Education?
Patient lay models refer to the personal, commonsense understanding or cognitive framework that patients develop to explain their illnesses and health conditions. These models are typically based on the patient’s individual experiences, culture, and available knowledge. In nursing education, lay models represent a patient-centered, constructivist approach to learning, where patients construct their understanding of their disease based on their perceptions and experiences rather than just medical information.
Leventhal’s theory of illness representation provides a structured way to analyze these lay models, which often include ideas about:
- Identity (how the patient identifies their condition),
- Cause (what they believe caused it),
- Timeline (how long they expect the illness to last),
- Consequences (what effects they anticipate),
- Cure or control (how they think the illness can be treated or managed).
These models are foundational to how patients interpret new health information and their ability to cope with illnesses. They are also known for being resistant to change, which poses a challenge in patient education efforts. Nurses and healthcare providers must address these lay models to deliver effective patient education.
Comparison to Traditional Education Interventions in Nursing
Traditional educational approaches often provide standardized information to all patients without first addressing their existing beliefs or understanding of their illness. In contrast, patient-centered education that incorporates lay models begins by asking patients to describe their illness in terms of their personal perceptions and experiences. This step is critical because it allows nurses to understand the patient’s existing misconceptions, fears, or inaccurate beliefs.
Once these beliefs are identified, educational interventions can focus on replacing misconceptions with accurate, evidence-based information, and reinforcing the benefits of following a healthcare plan. By integrating lay models into the educational process, nurses can improve engagement and adherence by ensuring that the patient’s unique understanding and perspective are addressed.
For instance, a pain management program might begin by having patients express their beliefs about the source of their pain, followed by education on pain mechanisms and strategies for control. The traditional approach would simply deliver pain management techniques without considering whether the patient believes they can manage their pain.
Studies support the importance of perceived controllability of illness in influencing patient behavior and outcomes. Patients who believe they have some control over their health tend to adopt more adaptive coping strategies, leading to better psychological well-being and social functioning. Therefore, engaging with and modifying lay models is critical to enhancing patient outcomes in nursing.
View of Lay Models and Practices Discrepant with Modern Medicine
Lay models can sometimes conflict with modern medical practice, especially when cultural beliefs or societal norms shape a patient’s understanding of their illness. An example is the case of Kashmiri men in Leeds, where cultural norms equate overweight with prosperity and well-being. These men struggled with managing their diabetes due to cultural dietary habits that include rich, fatty foods. The cultural belief in equating excess weight with health hindered their ability to effectively manage their disease, leading to low compliance with dietary and exercise recommendations.
Other examples include low-income African American patients with hypertension, where distrust in the medical system influenced their interpretation of frequent medication changes. They believed these changes indicated experimentation on them rather than a genuine effort to manage side effects. This distrust led them to noncompliance and reliance on advice from family or friends rather than healthcare providers. This illustrates the need for cultural competency in addressing lay models in nursing education.
Discrepancies between lay models and medical advice can lead to distress and dissatisfaction when healthcare providers fail to explore the patient’s existing beliefs. In a study of low-income Hispanic and African American women, women who had abnormal Pap smears believed they had cancer, associated the condition with sexual misbehavior, and misunderstood the concept of pre-cancer. They were often informed of their abnormal results by letter, leading to confusion about what the findings meant and what actions they needed to take. This lack of understanding could only be addressed through systematic probing of their beliefs, which was not routinely done in the healthcare setting.
Outcomes of Lay Model Usefulness in Nursing Education
Addressing and modifying lay models in patient education has been shown to improve patient outcomes, particularly in chronic disease management. For example, studies of patients awaiting coronary artery bypass graft (CABG) surgery revealed that older patients often believed that the surgery would eliminate their heart disease, leading to fewer health behavior changes compared to younger patients who viewed their condition as more controllable.
In the case of myocardial infarction (MI) patients, beliefs about the severity and lasting consequences of their condition were key determinants of recovery. Those who believed their MI would have severe long-term consequences experienced higher levels of disability and were slower to return to work. In contrast, those with stronger beliefs in their ability to control the disease were more likely to attend cardiac rehabilitation and improve their outcomes.
A randomized controlled trial (RCT) with MI patients demonstrated the effectiveness of interventions that began with exploring the patient’s beliefs about their illness. This approach helped patients adjust their beliefs about the causes of their MI, which led to the development of personalized care plans that included exercise, dietary changes, and guidance on returning to work. The intervention not only improved patients’ understanding but also reduced their likelihood of experiencing angina pain.
In the management of diabetes, personal models of the disease have been found to predict health outcomes such as glycemic control, physical functioning, and mental health. Patients who hold accurate, coherent models of diabetes are more likely to adhere to self-management behaviors that improve these outcomes.
Another example is in patients with dizziness and vestibular disorders. Individuals often have lay beliefs that associate dizziness with a fear of falling or losing control. An intervention that involved explaining the causes of dizziness and guiding patients through vestibular rehabilitation exercises led to a significant reduction in negative beliefs and improved functional outcomes. Patients who received the intervention were able to engage in exercises that desensitized their vestibular system, reducing their symptoms and fear over time.
Conclusion
Incorporating patient lay models of disease into nursing education is a critical step toward delivering patient-centered care. These models provide insight into how patients understand their illnesses and guide their coping strategies. By addressing and modifying these beliefs, nurses can create more effective education interventions that are tailored to each patient’s needs. This approach contrasts with traditional, one-size-fits-all educational methods, which fail to account for patients’ personal experiences and existing beliefs.
Lay models can sometimes conflict with modern medical practices, especially when influenced by cultural or societal norms. Therefore, understanding and addressing these discrepancies is vital for improving patient adherence, reducing distress, and ultimately achieving better health outcomes.
Research has consistently shown that addressing lay models can improve outcomes in patients with chronic conditions such as heart disease, diabetes, and vestibular disorders. As nursing education continues to evolve, integrating patient beliefs and experiences into the care process will remain an essential component of effective healthcare delivery.